When viewed within the entire current treatment landscape, the risks of alemtuzumab are worth the benefits, said Dr. Stüve. “The other player is natalizumab, which has a one in 250 chance of PML, and 20% of those patients die. So I don’t see why I should be squeamish about ITP,” which is treatable. “We should not withhold these kinds of drugs from patients who really need them,” he concluded.
Few Patients May Be Candidates for Alemtuzumab
In theory, Americans could seek treatment with alemtuzumab by traveling to a country where the drug has been approved. Neurologists, however, may discourage patients from traveling for this reason. “Most patients with MS should not be treated with alemtuzumab, so I see little need for anyone to go out of the country to receive it,” said Dennis Bourdette, MD, Director of the MS and Neuroimmunology Center at Oregon Health and Science University in Portland. Patients who chose this option would need extensive follow-up treatment for “autoimmune disease, particularly thyroid disease, platelet abnormalities, kidney dysfunction, and cancer,” he added. Alemtuzumab is a “toxic drug that should be used with great caution and in a small group of patients with active and difficult-to-control disease, perhaps 1% to 2% of cases at most,” concluded Dr. Bourdette.
—Whitney McKnight